Provider Demographics
NPI:1003132283
Name:LA BRYANT MANAGED CARE
Entity Type:Organization
Organization Name:LA BRYANT MANAGED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-731-4866
Mailing Address - Street 1:4750 BRINKLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-3828
Mailing Address - Country:US
Mailing Address - Phone:713-731-4866
Mailing Address - Fax:832-203-4069
Practice Address - Street 1:4750 BRINKLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-3828
Practice Address - Country:US
Practice Address - Phone:713-731-4866
Practice Address - Fax:832-203-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management